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The 2020 Democrats Divide Over Single-Payer Health Care

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An ABC/Washington Post survey released on Wednesday that asked the question in a different way—stressing that the current system leaves some people uninsured while the new system would provide universal coverage—found much broader support for the idea. Two-thirds of Democrats in that poll said they would still back “Medicare for all if it meant there was no private insurance option available.”

The divergence in these results suggests that opinions on the issue are still fluid and somewhat undefined. And that means the next stage of debate among Democrats could be critical in framing opinions about a government-run system, not only within the Democratic coalition but also, potentially, beyond it.

The CNN survey underscores that conclusion. It found Sanders, Warren, and Biden—in that order—all finished closely together among voters who would eliminate private health insurance (as the first two candidates have proposed), according to results provided to me by CNN polling director Jennifer Agiesta. Similarly, the poll found Harris leading, followed closely by Biden and more distantly by Warren and Sanders, among the plurality of Democrats who would preserve private insurance. That suggests this issue hasn’t yet shaped the race nearly as much as it could if the candidates delineate their differences more sharply.

Since his 2016 race for the nomination, Sanders has been the principal proponent of a single-payer system that would ban private insurance for all but peripheral services, such as cosmetic surgery. His camp sees his identification with single-payer as a key to victory in a crowded primary field. Sanders is worrying less about building majority support in the party than about consolidating a passionate third or so of Democratic primary voters—and no issue, his camp believes, is more important in helping him do that than single-payer. “For one-third of the primary electorate, it is going to be ‘screw the insurance companies, screw the pharmaceutical companies, I want to crush the whole system,’” says one top Sanders adviser, who similarly requested anonymity. “I am OK with having that debate. It is the debate we can win the nomination with.”

Sanders’s challenge is that Warren and Harris, who have both endorsed a single-payer plan that eliminates private coverage, are clearly encroaching on his support with the most liberal voters. He’s tumbled to fourth in some post-debate surveys, both nationally and in the kick-off state of Iowa. Meanwhile, South Bend, Indiana, Mayor Pete Buttigieg, while more moderate on issues including health care, is also cutting into the support among young people that propelled the Vermont senator last time.

Biden faces a different equation. His strongest support in the race so far has come from the voters the CNN poll shows are most resistant to a single-payer plan that eliminates private insurance: older voters, non-whites, and moderates.

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